This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Peterson, L. R. Articles by Quillen, J. E. Search for Related Content PubMed PubMed Citation Articles by Peterson, L. R. Articles by Quillen, J. E.

(Circulation. 1998;97:499-500.)
© 1998 American Heart Association, Inc.

Images in Cardiovascular Medicine

Sinus Node Artery Fistula

Linda R. Peterson, MD; Lowell F. Peterson, MD; Trevor A. Rattray, MD; ; James E. Quillen, MD

From Washington University School of Medicine, St Louis, Mo, and the Appleton Heart Institute, Appleton, Wis.

Correspondence to Linda R. Peterson, MD, Washington University School of Medicine, 660 S Euclid Ave, Box 8086, St Louis, MO 63110.

A 54-year-old asymptomatic white man had the chest radiographs and scan shown in Figures performed as part of an insurance physical examination.

View larger version (126K): [in this window] [in a new window]   Figure 1. Lateral chest radiograph.

View larger version (123K): [in this window] [in a new window]   Figure 2. Anteroposterior chest radiograph. White arrows point to round, calcified abnormality seen on lateral chest radiograph.

View larger version (94K): [in this window] [in a new window]   Figure 3. Image from patient's CT scan at midatrial level. LA indicates left atrium; RA, right atrium.

View larger version (132K): [in this window] [in a new window]   Figure 4. Ventriculogram (right anterior oblique projection). White arrow points to calcified abnormality, which is posterior to ascending aorta.

View larger version (138K): [in this window] [in a new window]   Figure 5. Angiogram of patient's right coronary artery (right anterior oblique view). White arrows point to calcified abnormality seen on chest radiograph and CT. Tip of catheter is down past takeoff of sinus node artery.

View larger version (65K): [in this window] [in a new window]   Figure 6. A. A selective injection of the sinus node artery fistula, through the round, calcified abnormality seen on flouroscopy. The thick white arrows point to the calcified area, and the thin white arrows show the flow from the sinus node artery into the right atrium. B. Another selective injection of the sinus node artery fistula with the white arrow pointing to the flow into the right atrium.

View larger version (125K): [in this window] [in a new window]   Figure 7. Intraoperative view of fistula.

View larger version (143K): [in this window] [in a new window]   Figure 8. Postexcisional view of fistula demonstrating end of fistula that opened into right atrium.

A decision was made with the patient to remove the fistula because of the risk of endocarditis, an increase in left-to-right shunt flow, and the risk of coronary steal. The patient tolerated the procedure extremely well and remained in sinus rhythm after surgery. A sinus node . . . [Full Text of this Article]